title: A population-based study on the influence of brain atrophy on 20-year survival after age 85.
abstract: BACKGROUND
  Individuals aged 80 years and older is the fastest growing segment of the population worldwide. To understand the biology behind increasing longevity, it is important to examine factors related to survival in this age group. The relationship between brain atrophy and survival after age 85 remains unclear.
  
  
  METHODS
  A population-based sample (n = 239) had head CT scans at age 85 and was then followed until death. Cortical atrophy and ventricular size were assessed. Statistical analyses included Cox proportional hazards models with time to death as the outcome and considering a large number of possible confounders, including baseline cognitive function, incident dementia, and somatic disorders.
  
  
  RESULTS
  Mean survival time (±SD) was 5.0 ± 3.6 years (range 0.10-19.8 years). Decreased survival was associated with temporal, and frontal atrophy, sylvian fissure width and a number of ventricular measures after adjustment for potential confounders. In participants without dementia at baseline (n = 135), decreased survival was associated with temporal lobe atrophy and bifrontal ratio. In those with dementia (n = 104), decreased survival was associated with third ventricle width, cella media ratio, and ventricle-to-brain and ventricle-to-cranial ratio.
  
  
  CONCLUSIONS
  Several indices of brain atrophy were related to decreased survival after age 85, regardless of dementia status. Brain atrophy is rarely mentioned as a significant indicator of survival in the elderly, independent of traditional predictors such as cardiovascular disease or cancer. The biology behind the influence of brain atrophy on survival needs to be further scrutinized.
authors.affiliation: Neuropsychiatric Epidemiology Unit, Wallinsgatan 6, 43141 Mölndal, Sweden.
authors.forename: P J
authors.initials: PJ
authors.lastname: Olesen
authors.forename: X
authors.initials: X
authors.lastname: Guo
authors.forename: D
authors.initials: D
authors.lastname: Gustafson
authors.forename: A
authors.initials: A
authors.lastname: Börjesson-Hanson
authors.forename: S
authors.initials: S
authors.lastname: Sacuíu
authors.forename: C
authors.initials: C
authors.lastname: Eckerström
authors.forename: E D
authors.initials: ED
authors.lastname: Bigler
authors.forename: I
authors.initials: I
authors.lastname: Skoog
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D018672:Community Health Planning; D003704:Dementia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D003863:Depression / Q000175:diagnosis; D006801:Humans; D008137:Longitudinal Studies; D019636:Neurodegenerative Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods